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11080179 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10237 UNIVERSITY WAY CONTRACTOR:MARVIN DAVIS PERMIT NO: 11080179 CONSTRUCTION OWNER'S NAME: TERRY Y AND ANNIE T HO 1450 KOLL CIR DATE ISSUED:08/24/2011 ER'S PHONE: 4088938555 SAN JOSE,CA 95112 PHONE NO:(408)975-0200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L'S Lic.# NI 3 q Z-,-, MECH f— RESIDENTIAL COMMERCIAL r Contractor 0. Date r e JOB DESCRIPTION:REMODEL SINGLE FAMILY DWELLING KITCHEN DUE TO I hereby affirm t ra am hcenseb un er the provisions of Chapter 9 FIRE(]30SQFT);UPGRADE ELECTRICAL TO CODE,REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions RANGE,HOOD,WASHER/DRYER,SINK,FAUCET,CABINETS,DRYWA Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$14000 permit is issued. APPLICANT CERTIFICATION APN Number:32623040.10237 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued - Date: Signature _Date 8' i L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous in requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner or author /�.J�.___�\� Date: 'L � forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of murk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save '-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g.,,nting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32623040 .10237 DATE ISSUED. . . . . . . : 08/24/2011 RECEIPT #. . . . . . . . . BS000014551 REFERENCE ID # . . . : 11080179 SITE ADDRESS 10237 UNIVERSITY WAY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TERRY Y AND ANNIE T HO ADDRESS . . . . . . . . . . : 10237 UNIVERSITY WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MARVIN DAVIS CONSTR CONTRACTOR . . . . . . . : CHARLES DRISCOLL LIC # 22989 COMPANY MARVIN DAVIS CONSTRUCTION ADDRESS . . . . . . . . . . : 1450 KOLL CIR CITY/STATE/ZIP SAN JOSE, CA 95112 TELEPHONE (408) 975-0200 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 14, 000 .00 1. 00 0. 00 1 . 00 0 . 00 1BSEISMICR VALUATION 14, 000 . 00 1.40 0 . 00 1.40 0 . 00 1REMRESKIT SQ FEET 130 . 00 588 . 00 0 . 00 ----588_00 ------0_00 ---------- ---------- TOTAL PERMIT 590.40 0. 00 590 .40 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CHECK 590 .40 #51532 --------------- TOTAL RECEIPT 590 .40 I l O� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinp(d_)cuPertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# �J `'© (� IOz..37 , �e.t-ate W � v OWNER NAME ` PHONE LIOv g,el3 ��5.f E-MAIL Prv%v.�d.. �p STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME M,_y�/1h Ile..V�.s lA1'�S K�'O�f/X_ PHONE LJOSI' '17S- D'L"o E-MAIL VVI,, I..` �1 ft, &,ont�•4AD STREET ADDRESS CITY,STATE,ZIP FAX t'{S o llcotl ( ,v. ko s�_e 46 to Sum J'os4- Lf� Stl z a Y y 7S O U D ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# 3 t4 Z.o d COMPANY NAME I �+ E-MAIL FAX lk - Dp,�/t�S �r>t 4'Y'Ni��✓1 Sw+G vvw_$,-e� L K%&L Ln 9%&�-. C.0 r K L(D Y p V p K� STREET ADDRESS CITY STATE,ZIP PHONE %Lt5 `` (. LV f_ "O To f,2 C A— 4).S-I I Z Yo T' S d Z0 v ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE FESCRIPTION OF WORK po 2JC o�r QiY' S. Q- a' v I a1 EXISTING S PROPOSED USE CONSTR. E #STORJES USE TYPE OCC. SQ.FT. VALUATION($) � Y// NEW FLOOR DEMO TOTAL AREA (1 l AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAR*,, S REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: LJ DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY .2TAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? [:] �NO )y O By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: S./-Jq I I SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for COUNTER LJ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PuBmcwom form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10237 university way DATE: 08/24/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: $14,000 r°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY SFD or Du lex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK remodel sfd kitchen due to fire damage. SCOPE NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (1,ee Resolution 11-053.L?—L..';'!.%111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 130 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: G Reg. 0 OT F6.761 hrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee40 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (F) No $0.00 0 Work Without Permit? 0 Yes G No $0.00 E) Plannin; Fee: $0.00 Select a Non-Residential E) Building or Structure i Strom Motion Fee: IBSEISMICR $1.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.40 $588.00 TOTALIZE $5 10.40 Revised: 07/04/2011 PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1 P1 O� cDL1 P�R7` (408)777-3228• FAX(408)777-3333 •building cugertino.org PROJECT ADDRESS 7APN# 023-7 ti OWNER NAMFPHONE E-MAIL Anh�c t� 8.93 mss STREET ADDRESS CITY, STATE,ZIP FAX APPLICANT NAMELL,, T PHONE E-MAIL I / YV,V% 0.V h IM1077J'Y( �. C)Q� I7S �20o rnQrL MOS �l7hf("•l0 STREET ADDRESS t L CITY,STATE, ZIP FAX -gJ o a- C, q.S` 2 n S/g 7S-O �o ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT .ff CONTRAcrOR ❑CONTRAcrOR AGENT ❑ ARCHITECT /❑ENGINEER/ ❑ DEVELOPER !!❑TENANT DESCRIPTION OF WORK /�,}} G.►L r`pLr� � Wrt L� Gpit,�i�,.t/O EXISTING USE(S): PROPOSED USE(S): l�•L OCCUPANCY(S): TYPE OF T�- PARCEL CONSTRUCTIO�� AREA: FIRE SPRINKLERS: Y 1,0N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N Existing Proposed Floor Area: First Floor: - s.f. S.f. Second Floor: s.f s f _ Garage s.f- S �� C_. . TOTAL: s.f. SA. Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y NI)SPAASMSST 1 D�Sp Z_G PERS1Np Governing Codes: 2010 California Building Code (based on the 2009 Int C � tat the 2010 California Residential Code (based on the 2009 Intern conal �cde)_UST be kep any 2010 California Plumbing Code(based on the 2009 Uniform Plum>in -'10t1ons ��to make 2010 California Mechanical Code(based on the 2009 Unif , � �pgdte un\or to de J%ate 2010 California Electrical Code(based on the 20CTANCR4� Taw 'M' , u-009 Gttt°1a,. 2010 California Energy Code lob SWIE n or a rove,Nom e 6 SHAD L W'T 2010 California Green Building Standards Code c pm,W,thout SPP S eclficst}ons e vto�G ton Cupertino Municipal Code then amP�ng 01 thI�to bA en approvaCef%i or State�aW Me held to Po"'ston01 s isidential.doc C;%W Ordinan IDI any P;SEPe�M�'j NS�r revised 03/09/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: v231 'vl lrstVJ PERMIT# cF�l7 OWNER'S NAME: PHONE# qwp V — 417S' ' GENERAL CONTRACTOR: C.0 BUSINESS LICENSE# ` CITY/ZIPC ADDRESS: a V.vL\ u�-te- S'� ODE: s-717i *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical M Q e Excavation Fencing Flooring / Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile - Owner/Contractor Signature Date